Dosimetric evaluation of pediatric abdominal and pelvic radiographs: Optimization and diagnostic reference levels

Abstract

Abdominal and pelvic radiography are essential for detecting pediatric trauma and injuries but present increased radiation risks to nearby sensitive organs due to children's smaller body size. Furthermore, the growing use of pediatric medical imaging has raised concerns about radiation exposure, as children are more radiosensitive and vulnerable to cancer, a risk often intensified using non-dedicated and non-optimized X-ray equipment. This study evaluates the kerma-area product (KAP) and incident air kerma (K_a,i) in pediatric abdominal and pelvic radiographic examinations. Conducted at a specialized pediatric hospital, the analysis included data from 279 patients aged up to 18 years, obtained using a Shimadzu digital X-ray equipment specifically configured for pediatric imaging. The study explored correlations between radiation doses and patient characteristics, such as age, weight, and anatomical thickness. The findings highlight significant dose variability, particularly in older children (10–18 years), due to anatomical differences and potential inconsistencies in radiographic protocols. Younger children (<1 year) exhibited lower variability, benefiting from standardized protocols. However, weight- and thickness-based classifications proved more effective for dose optimization than age-based groupings, especially for older and heavier patients. Outliers exceeding international pediatric Diagnostic Reference Levels (DRLs) were identified, emphasizing the need for enhanced protocol adherence.